Background

A group panel at table

The “Boulder conference” and its “scientist-practitioner” ethic (cf., Belar, 2000; Benjamin & Baker, 2000; Gaudiano & Statler, 2001) are rightly considered a cornerstone of doctoral training in general. However, a robust and relevant debate over specifics (e.g., how students should be trained, what knowledge, skills, and competencies should be mastered; how programs should articulate and actualize their training objectives) continues to this day (e.g., Belar, 1998; CoA Self-Study, 2002; Fox, 1994; Resnick, 1997; Peterson, Peterson, Abrams, & Stricker, 1997; Shapiro & Wiggins, 1994; Smith, 2001).

At the same time, a consensus appears to be emerging that applied and professional psychology is "at a critical juncture in the continuing evolution of the field" (Olvey, Hogg, & Counts, 2002, p. 327). Although the "causes" of our current situation are economic and historic and well as complex and multidetermined, the effects are not in doubt: the students we are producing are too often saddled with post-graduate debt that will not be covered by the incomes they can reasonably expect in an increasingly competitive milieu, and the time expected of them to obtain licensure seems difficult to justify in terms of costs and benefits. As Olvey, Hogg, and Counts (2002) starkly conclude,

“if earnings for psychologists continue to decline, the demographics of students seeking admission into graduate programs of psychology are likely to mirror admissions into lower wage helping professions such as social work or masters-level counseling programs….When compared to other professions, professional psychologists are clearly at the top-of-the-line in terms of requirements for licensure. It is also apparent that psychologists lie near the bottom-of-the-heap in terms of earnings…From a big picture perspective, psychology needs to develop a stronger base by broadening its paradigm to focus on a whole range of occupations for its professionals (pp. 327-328).”

Complicating matters, it is not at all clear that the training we provide to students reliably predicts either the perception of the professional competencies or their eventual employment outcomes. For example, data from the Association of Psychology Postdoctoral and Internship Centers (APPIC), suggests that internship training directors across a wide range of program types "prefer" or "accept" applicants in a manner that is not predicted by the doctoral program area in which they were trained (e.g., clinical, counseling, or school) (APPIC, 2003). Likewise, data from the Committee on Accreditation of the American Psychological Association indicate that students trained in clinical, counseling, and school psychology are employed across a wide and often overlapping range of employment settings (APA, 2002). Not surprisingly in relation to such perceptions and outcomes, it has proved exceedingly difficult to clarify what are the real and substantive distinctions between the "specialty areas" of clinical, child clinical, counseling, or school psychology; in fact, all four of these areas rightly note that their practitioners work with most of the same clinical populations, presenting problems, and procedures (see Cobb, 2002; www.apa.org/crsppp). In addition to these challenges, the field has not yet resolved a number of other vexing problems having to do with fundamentals of training sequence and specialization and relevance to the current job market (Williams-Nickelson, 2001).

Fortunately, over the past several years, a range of conferences and initiatives within the larger field of professional psychology have addressed aspects of the larger problem in a comprehensive and systematic manner, and have essentially provided crucial “pieces” of a larger puzzle that might now be assembled into a more coherent and appealing whole. Such activities and policies include, but are not limited to, the inaugural Education Leadership Conference (Belar, 2002), the educational model of the National Council of Schools and Programs of Professional Psychology (Peterson et al., 1997), Competencies 2002: Future Directions in Education and Credentialing in Professional Psychology (Kaslow & Vasquez, 2002; see www.appic.org), the Commission on Education and Training Leading to Licensure in Psychology (see Williams-Nickelson, 2001), and the Comprehensive Principles for Health Services Specialization in Professional Psychology (see www.apa.org).

At a crucial and complementary level, there is a growing perception—now codified into regulation at a federal level and in a number of licensure contexts—that professional psychology and applied psychologists (e.g., in clinical, counseling, and school psychology) are rightly considered “health care providers,” broadly defined. As the new Chief Executive Officer of the American Psychological Association notes, “Now that the scientific foundation for psychology as a health profession has been established, the challenge for us is to move to the center of health care delivery systems and be viewed as health care providers more generally” (Anderson, 2003, p. 9). This conceptual framework provides important opportunities for applied and professional psychology to redefine its identity and the nature and scope of its impact within the broader health care field. Such possibilities are revealed most dramatically, perhaps, in the new Graduate Psychology Education program, which was established in the Bureau of Health Professions in 2002, and provided $2,000,000 for the education and training of psychologists and the doctoral and internship level. This program is the first ever designed explicitly and exclusively for doctoral-level psychology training. As significant, at a statutory level, GPE is explicitly “…targeted to health service psychologists, who provide evidence-based services in the prevention, diagnosis, treatment, and rehabilitation of a wide range of behavioral health problems” (Levitt, 2003, p. 2).

In consideration of all of these interrelated issues, which directly relate to the nature, scope, and future of education, training, and practice in professional psychology—and in the context of a growing chorus of voices which advocates for a more unified and integrated approach to psychology in general and professional practice in particular (e.g., Norcross, 2002; Shealy, 2002; Sternberg, 2001)—a three-day Consensus Conference on Combined and Integrated Doctoral Training in Psychology was held May 2-4, 2003, at James Madison University in Harrisonburg, Virginia. The participants, sponsors, goals, structure, and results of the Consensus Conference are described below.